Intra-operative carcinoid crisis: Revised anaesthesia management

Kromas, Michelle L; Passi, Yuvesh; Kuzumi, Chika; Shikhar, Soni

doi:10.4103/ija.ija_161_17

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…It is characterized by severe flushing, diarrhea, hypotension, and arrhythmias. Prophylactic continuous intravenous octreotide infusion is usually given during the procedures to prevent a carcinoid crisis [20][21].…”

Section: Clinicalmentioning

confidence: 99%

Carcinoid Syndrome: A Review

Gade¹,

Olariu²,

Douthit³

2020

Cureus

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Carcinoid syndrome (CS) is a paraneoplastic syndrome caused by the release of serotonin and other substances from well-differentiated neuroendocrine tumors (NETs). The hallmark symptoms of carcinoid syndrome are flushing and diarrhea; atypical signs and symptoms can include wheezing, abdominal pain, valvular heart disease, telangiectasias, pellagra, and the complications of mesenteric fibrosis, including ureteral obstruction, bowel obstruction, and bowel ischemia. These symptoms are mediated by the release of serotonin (5-HT), histamine, kallikrein, prostaglandins, and tachykinins. The diagnosis of CS requires these symptoms and corresponding elevations in lab tests. Treatment options include surgery and medical management with somatostatin analogs.

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Section: Clinicalmentioning

confidence: 99%

Carcinoid Syndrome: A Review

Gade¹,

Olariu²,

Douthit³

2020

Cureus

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“… 4 Additionally, succinylcholine, β 2 agonists, and drugs that promote excessive catecholamine release may lead to NET secretion. 12 To optimize hemodynamics, the somatostatin analog octreotide is recommended before surgery. Somatostatin analogs inhibit secretions of growth hormone, insulin, somatostatin, thyrotropin, and likely all intrinsic and extrinsic gut hormones.…”

Section: Discussionmentioning

confidence: 99%

“…Research has shown that the operative course cannot be predicted by the severity of preoperative carcinoid symptoms or the level of elevation of urinary 5-hydroxyindoleacetic acid. 12 Therefore, similar precautions should be taken with all patients undergoing surgery who have carcinoid tumors.…”

Section: Discussionmentioning

confidence: 99%

Incidental Diagnosis of Carcinoid Disease by Intraoperative Transesophageal Echocardiography and Subsequent Discovery of a Neuroendocrine Tumor during Cardiac Surgery

Martin

Wanat-Hawthorne

Sanjeevaiah

et al. 2020

CASE

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“…As previously shown in Table 1, not only direct manipulations of tumor mass, such as bronchoscopy [16,20], liver biopsy [13,16] or locoregional treatments [18,21], but also other kinds of tumor solicitations, such as the induction of anesthesia [14] or the infusion of radiotracers [17], can contribute to the rapid onset of CC. In addition, following the results of the NETTER-1 trial, the increasing use of peptide radionuclide therapy (PRRT) has led to a rise in CC due to tumor lysis [22], most frequently after the first cycle of treatment, and the main risk factors include large tumor burden, liver metastases, previous CS, carcinoid heart disease, advanced patient age, high chromogranin A levels and high 5-HIAA levels.…”

Section: Clinical Definition and Presentationmentioning

confidence: 99%

“…Furthermore, clinical presentation is remarkably variable. For instance, Kromas et al, described a case of a 31-year-old woman who presented chest pain, newly onset asthma and a sudden onset of hypotension and wheezing during rigid bronchoscopy [20]. Koopmans et al reported the case of a 61-year-old woman who developed vomiting, accompanied by flushing, edema and severe hypotension during an 18F -DOPA PET scan [17].…”

Section: Clinical Definition and Presentationmentioning

confidence: 99%

Carcinoid Crisis: A Misunderstood and Unrecognized Oncological Emergency

Bardasi

Benatti

Luppi

et al. 2022

Cancers

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Carcinoid Crisis represents a rare and extremely dangerous manifestation that can occur in patients with Neuroendocrine Tumors (NETs). It is characterized by a sudden onset of hemodynamic instability, sometimes associated with the classical symptoms of carcinoid syndrome, such as bronchospasm and flushing. Carcinoid Crisis seems to be caused by a massive release of vasoactive substances, typically produced by neuroendocrine cells, and can emerge after abdominal procedures, but also spontaneously in rare instances. To date, there are no empirically derived guidelines for the management of this cancer-related medical emergency, and the available evidence essentially comes from single-case reports or dated small retrospective series. A transfer to the Intensive Care Unit may be necessary during the acute setting, when the severe hypotension becomes unresponsive to standard practices, such as volemic filling and the infusion of vasopressor therapy. The only effective strategy is represented by prevention. The administration of octreotide, anxiolytic and antihistaminic agents represents the current treatment approach to avoid hormone release and prevent major complications. However, no standard protocols are available, resulting in great variability in terms of schedules, doses, ways of administration and timing of prophylactic treatments.

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Intra-operative carcinoid crisis: Revised anaesthesia management

Cited by 6 publications

References 7 publications

Carcinoid Syndrome: A Review

Carcinoid Syndrome: A Review

Incidental Diagnosis of Carcinoid Disease by Intraoperative Transesophageal Echocardiography and Subsequent Discovery of a Neuroendocrine Tumor during Cardiac Surgery

Carcinoid Crisis: A Misunderstood and Unrecognized Oncological Emergency

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